Louisiana
Expansions, Simplifications and Outreach
Background/History
In the late 1990’s, the state of public health coverage for children in Louisiana was a bad news-good news scenario. The bad news was that nearly 32 percent of children in the state with family incomes at or below 200 percent of the federal poverty level (FPL) were uninsured. State officials identified a number of contributing factors: 1) a conservative children’s Medicaid program that covered only federal mandatory groups; 2) high poverty rates; and 3) low literacy levels state-wide, making it difficult for people to navigate the eligibility system.
The good news was that the state’s Medicaid program had a number of positive elements on which to build:
- Mail-in renewal since 1992
- No asset tests
- Most eligibility workers were not stationed in the welfare agency
- A strong benefits package
- 300+ community-based application centers
As a result, when federal State Children’s Health Insurance Program (SCHIP) dollars became available in 1998, Louisiana decided to launch its SCHIP program as a Medicaid expansion, called LaCHIP (Louisiana Children’s Health Insurance Program). By using Medicaid as the vehicle for expansion, health officials hoped to eliminate the need for cross-program coordination, use existing Medicaid staff as an outreach resource, and make sure simplification and streamlining for the SCHIP population would also benefit the Medicaid population. The state now calls its Medicaid and SCHIP expansion by the one name of LaCHIP.
Over the ensuing nine years, Louisiana marched steadily and aggressively toward substantial improvements in insurance coverage for low-income children. The state’s efforts focused on several key areas of work:
- Expanding eligibility. Before SCHIP, Louisiana covered children ages 0-19 in Medicaid up to 133 percent of the FPL. Work was undertaken to increase coverage to more children by expanding eligibility. By January 2001 the state had expanded coverage up to 200 percent of the FPL. The state does not provide health coverage to immigrants who are
not eligible for coverage under Medicaid/SCHIP.
- Increasing retention. While enrollment was expanding, health officials noted a simultaneous “hole in the bucket” effect on the other end: high levels of case closure at renewal (exceeding, at times, the number of new children enrolled). In April 2000, the Louisiana Department of Health and Hospitals, Bureau of Health Services Financing (BHSF; the agency that administers LaCHIP) began considering ways to implement new clarification of existing ex parte law, which requires states to base renewals “to the maximum extent possible” on information already known to the agency. In October 2001 a retention analysis report commissioned by BHSF laid out a blueprint for a multi-faceted response to this problem.
- Pursuing aggressive outreach. LaCHIP, with state agencies and other partners, undertakes substantial statewide outreach efforts throughout the year.
Browse
- Summary
- Background/History
- Support/Opposition
- Program Elements
- Funding
- Results
- Lessons Learned
- Contacts
View
Download
Last Updated
February 2008
Louisiana
Expansions, Simplifications and Outreach
Background/History
In the late 1990’s, the state of public health coverage for children in Louisiana was a bad news-good news scenario. The bad news was that nearly 32 percent of children in the state with family incomes at or below 200 percent of the federal poverty level (FPL) were uninsured. State officials identified a number of contributing factors: 1) a conservative children’s Medicaid program that covered only federal mandatory groups; 2) high poverty rates; and 3) low literacy levels state-wide, making it difficult for people to navigate the eligibility system.
The good news was that the state’s Medicaid program had a number of positive elements on which to build:
- Mail-in renewal since 1992
- No asset tests
- Most eligibility workers were not stationed in the welfare agency
- A strong benefits package
- 300+ community-based application centers
As a result, when federal State Children’s Health Insurance Program (SCHIP) dollars became available in 1998, Louisiana decided to launch its SCHIP program as a Medicaid expansion, called LaCHIP (Louisiana Children’s Health Insurance Program). By using Medicaid as the vehicle for expansion, health officials hoped to eliminate the need for cross-program coordination, use existing Medicaid staff as an outreach resource, and make sure simplification and streamlining for the SCHIP population would also benefit the Medicaid population. The state now calls its Medicaid and SCHIP expansion by the one name of LaCHIP.
Over the ensuing nine years, Louisiana marched steadily and aggressively toward substantial improvements in insurance coverage for low-income children. The state’s efforts focused on several key areas of work:
- Expanding eligibility. Before SCHIP, Louisiana covered children ages 0-19 in Medicaid up to 133 percent of the FPL. Work was undertaken to increase coverage to more children by expanding eligibility. By January 2001 the state had expanded coverage up to 200 percent of the FPL. The state does not provide health coverage to immigrants who are
not eligible for coverage under Medicaid/SCHIP.
- Increasing retention. While enrollment was expanding, health officials noted a simultaneous “hole in the bucket” effect on the other end: high levels of case closure at renewal (exceeding, at times, the number of new children enrolled). In April 2000, the Louisiana Department of Health and Hospitals, Bureau of Health Services Financing (BHSF; the agency that administers LaCHIP) began considering ways to implement new clarification of existing ex parte law, which requires states to base renewals “to the maximum extent possible” on information already known to the agency. In October 2001 a retention analysis report commissioned by BHSF laid out a blueprint for a multi-faceted response to this problem.
- Pursuing aggressive outreach. LaCHIP, with state agencies and other partners, undertakes substantial statewide outreach efforts throughout the year.
Browse
- Summary
- Background/History
- Support/Opposition
- Program Elements
- Funding
- Results
- Lessons Learned
- Contacts
View
Download
Last Updated
February 2008